In her most recent book, Your Dieting Daughter, Carolyn Costin provides great insight as to the issues that underly eating disorders. Below are the 14 “Real Issues” that contribute to and perpetuate eating disorders. Food and weight are merely the symptoms of deeply-rooted issues.

Parents often wonder how and why their daughter started the self-destructive dieting and eating disordered behaviors. Carolyn Costin states, “I refer to these as, ‘The Real Issues’ because they are the issues that help to propel someone from a diet to a disorder. You will find here a list called, “The Real Issues” with examples of statements from clients.” The “Real Issues”:

1. Low Self-Worth “I’m afraid of myself and who I am.” “I’m no good.”

2. Belief in a Myth “Thinner people are happier.” “If I eat certain foods (butter, pasta, dessert), I will get fat.”

4. Filling Up An Emptiness “Something is missing in my life and food takes its place.” “I feel empty inside and by starving I make my outside match this.”

5. Need for Perfection/Black and White Thinking “I have to be the best at everything I do.” “I am either thin or fat.”

6. Desire to be Special or Unique “I get a lot of attention for my ability to control my weight.” “What will I be without my eating disorder?”

7. Need to be In Control “I’m proud of the willpower it takes to restrict.” “This is the one thing no one has control over but me.”

8. The Issue of Power “I get back at my parents through my eating disorder.” “When I can’t control others, I control food.”

9. Respect and Admiration “People admire those who are thin.” “Showing restraint is a sign of success.”

10. Has Hard Time Expressing Feelings “I think I’m asking for help through my eating disorder behaviors.” “When I starve I don’t feel things as much as when I am well fed.”

11. Doesn’t Have Coping Skills So the Eating Disorder is a “Safe Place to Go.” “I need to be taken care of and losing weight is a safe way to get it out.” “I am afraid of growing up and anorexia keeps me from having to.”

12. Lack of Trust in Self and Others “I don’t trust my body, so I follow rules and can’t stop.” “I can’t trust how anything is going to turn out, except how certain food will taste.”

13. Terrified of Not Measuring Up “I won’t have anything if I don’t have my eating disorder.” “I’m constantly comparing myself and have to eat less than everyone.”

14. High Achievement Oriented “Starving is a real achievement, mind over matter, literally.” “I have to work harder and harder at everything, even dieting.”